Probiotics for SIBO: Which Are Best?

Gut health disorders are becoming increasingly common. Typical symptoms include frequent bloating and changes in bowel routine. 

Identifying the root cause of these symptoms can be challenging because they overlap with several gut health disorders, including irritable bowel syndrome and small intestinal bacterial overgrowth (SIBO.)  

In this article, you’ll learn more about SIBO and treatment options, if probiotics can help with SIBO, and why working with a registered dietitian is essential for long-term success. 

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What is SIBO?

Small intestinal bacterial overgrowth (SIBO) is when excessive amounts of bacteria populate the small intestine. The high volume of these bacteria can alter gut function and produce mild to moderate digestive symptoms in people. Common symptoms include:

• Bloating. 
• Motility disorders.

• A motility disorder refers to changes in contractions of your gastrointestinal tract that help push digested food through your system.
• Slower motility can result in food staying in the gastrointestinal tract for longer, worsening symptoms and discomfort. 

• Sometimes diarrhea. 
• Brain fog. 

Diagnosing SIBO can be challenging because the symptoms are broad. Sometimes they overlap with irritable bowel syndrome, making SIBO harder to identify. If you suspect you have SIBO, you can take our SIBO quiz to learn if it fits your current health. 

Different Types of SIBO 

There are three classifications of SIBO: methane SIBO, hydrogen-dominant SIBO, and hydrogen-sulfide dominant. Completing testing with a specialist to diagnose your SIBO type is vital for building your treatment plan. 

Two standard tests for SIBO include: 

1. A non-invasive hydrogen breath test to measure the concentration of hydration in your exhalation.
2. A small fluid sample is collected from the small intestine and assessed for bacterial presence.  

What Are Probiotics? 

A probiotic is a microscopic living organism that can promote health. These tiny bacterial agents live throughout your gastrointestinal tract and have been linked to the following:

• Improving bowel habits - relieving constipation, antibiotic-associated diarrhea, and diarrhea caused by cancer treatment.  
• Easing symptoms of several digestive disorders - diverticular disease, irritable bowel syndrome, and irritable bowel disease. 
• Ongoing research studies investigate the link between probiotics, mental health disorders, weight management, and liver health. 

Most probiotic products are available in capsules, liquid beverages, or sometimes added to foods such as yogurts. 

Naturally Occurring Probiotics

Fermented foods are known to carry higher levels of bacteria. These include sauerkraut, kimchi, kefir (drinkable yogurt), yogurts, kombucha (fermented tea), etc. 

These foods can help maintain healthy bacteria levels in your digestive tract, but if you have SIBO, you may want to limit your intake. They can add more bacteria to your gut, prolonging your symptoms. Your dietitian can tell you if these foods are appropriate for you. 

Can Probiotics Help With SIBO? 

There is conflicting information if probiotics can help with SIBO. SIBO refers to the overgrowth of bacteria in your small intestine, and adding more bacteria via probiotics may not be helpful for some people.  

Without a clear guideline, you should only take recommended strains of bacteria under the guidance of a registered dietitian specializing in gut health or a gastroenterologist (a medical doctor specializing in digestive health.) 

For now, make small gradual changes to try and heal your gut, such as identifying and eliminating trigger foods. Follow the guidance of a dietitian specializing in SIBO and avoid overhauling your diet and lifestyle overnight.

Too many changes (even positive ones) can make it harder to identify which treatments truly benefit your healing process. 

What Types of Probiotics Are Good for SIBO? 

There is a limited number of probiotics that are proven to be effective for SIBO symptoms. 

A small study suggests that Saccharomyces boulardii combined with metronidazole medication may relieve SIBO symptoms.

This generic yeast-based probiotic bacteria strain can be purchased at most pharmacy retail outlets without a prescription. 

Other research suggested that probiotics can lessen hydrogen-dominant SIBO symptoms while using probiotics, but the specific strains of bacteria were not outlined. These preliminary findings suggest that probiotics may help manage the symptoms but do not target the underlying cause of SIBO. 

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When Should I Take Probiotics to Manage My SIBO Symptoms? 

You should resolve the majority of your SIBO symptoms before starting a probiotic.

There is a risk that adding more bacteria to your diet can compound SIBO symptoms and make you feel worse. 

To heal SIBO symptoms, you should complete a diet review with a registered dietitian. They can help you make nutritional changes to improve your symptoms.

Their suggestions will be highly individualized, and your dietitian may recommend a low FODMAP protocol.

This restrictive diet temporarily eliminates foods that can exacerbate gut symptoms, which can be a great relief. 

Your doctor may prescribe broad-spectrum antibiotics to decrease the number of bacteria in the small intestine and reduce overgrowth. 

Researchers suspect that reducing undesirably SIBO bacteria allows the gut to replenish health-promoting bacteria instead.

These agents can help sustain healthy gut function, and a probiotic may help restore bacterial colonies at this point in the treatment plan. 

Possible Side Effects

A probiotic may worsen SIBO symptoms, including gas, bloating, and even brain fog. It is unclear how a person will react to probiotics, and focusing your treatment efforts on other areas (such as diet and lifestyle changes) may be more worthwhile.   

Tips for Choosing the Right Probiotics

If you want to see results, you need to choose a probiotic strain proven to help with symptoms.

A generic probiotic supplement is unlikely to be beneficial because each strain helps with a specific health benefit. It can be hard to easily access this information because it is written in highly technical scientific language. 

Working with a gastroenterologist or a registered dietitian can help clarify which probiotic may be helpful for you. They are trained in deciphering scientific literature and can offer clear, simple steps to support your health journey. 

You and your provider can refer to the American Probiotic Chart for evidence-based suggestions. The chart also offers helpful tips, such as how often to take a probiotic and how to store them to maintain their shelf life. 

Takeaway

If you have SIBO, you may or may not benefit from probiotics. The gut disorder symptoms are highly individualized, and strategies to help you feel your best may evolve as you make changes. The first treatment action should focus on diet and lifestyle changes, followed by rounds of antibiotics, as a specialist recommends. 

Once SIBO symptoms resolve, you may want to try a probiotic to help maintain overall gut health, but you should only take a probiotic recommended by a dietitian. Unnecessarily adding more bacteria to your intestines may worsen SIBO symptoms.  

How a SIBO Dietitian Can Help

Taking back control of your gut health is possible with the help of a nutrition expert. A dietitian specializing in SIBO can help you identify and eliminate trigger foods, manage SIBO symptoms, and help you feel more confident in your food choices.

‍Find a dietitian near you to get started today for as little as $0—94% of our patients pay nothing out of pocket.